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Organization
SKATES-N-MOTION
Active
Organization
SKATES-N-MOTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGELO LORENZO HOLT (EXECUTIVE DIRECTOR)
(404) 914-1912
Entity
Organization
Contact information
Practice address
5878 COVINGTON HWY STE E, DECATUR, GA 30035-3745
(404) 914-1912
Mailing address
296 ROY HUIE RD, RIVERDALE, GA 30274-1867
(404) 914-1912
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
NULL
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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